Blade insert illuminator

ABSTRACT

An air gap retractor illumination system includes any suitable retractor with a channel in the blade to accommodate an air gap illuminator. The illuminator is preferably made from a suitable light conducting plastic material. The illuminator has active portions in which light passes and inactive or dead zones in which light does not pass. The illuminator is formed to have an air gap surrounding any active portion of the illuminator extending from the light input to the light output portion. The dead zones may include elements to allow the illuminator to securely engage the retractor. The light output portion of the illuminator contains from two to eight output zones, each zone having specially designed output optical structures that control and direct light to escape the illuminator to shine onto a predetermined area of interest or to form one or more predetermined shapes or footprints.

CROSS-REFERENCE

The present application is a continuation of U.S. patent applicationSer. No. 11/923,483 now U.S. Pat. No. 8,088,066 filed Oct. 24, 2007; theentire contents of which are incorporated herein by reference.

FIELD OF THE INVENTION

The inventions described below relate to the field of medicine and morespecifically, to providing in vivo surgical field illumination duringsurgical procedures.

BACKGROUND OF THE INVENTION

Surgical procedures often employ the use of retractors to separate andhold tissue to expose the underlying tissue on which the procedure is tobe performed. Blade retractors are a type of retractor that typicallyhave a flat or slightly curved blade that is inserted into the body. Theblade may have a handle portion that is used to manipulate the blade.One or more blade retractors may be used in a surgical procedure.Illumination in these procedures is typically limited to externalillumination sources such as ceiling or wall mounted lights or lightsources integrated into a headband worn by the surgeon (e.g., LED basedor fiber optic based). These light sources provide poor illumination ofthe deep tissue on which surgery is to be performed. Fiber optic devicesmay be fixed to a blade retractor to shine light on the deep tissue, butfiber optic systems either provide a small spot of light requiringconstant repositioning to view all the tissue, or they provide a verydiffuse light that does not adequately illuminate the tissue ofinterest. The fiber optic also has a very small emission area. Anydebris or blood that covers it will block the majority of illumination.Furthermore, fiber optic devices are very expensive, requiringspecialized cutting, grinding and polishing. Some blade retractors areprovided with length-wise channels into which ancillary retracting orillumination devices may be inserted. Blade insert illumination devicesare currently limited to fiber optic approaches with their poorillumination characteristics.

SUMMARY OF THE INVENTION

A retractor with an air gap illuminator uses any suitable retractor suchas McCulloch, and includes a channel in the retractor blade toaccommodate the illuminator. The illuminator is preferably made from asuitable light conducting plastic material such as acrylic orpolycarbonate or silicone. The illuminator is also formed to have an airgap surrounding any active portion of the illuminator from the lightinput to the light output portion. The illuminator has active portionsin which light passes and inactive or dead zones in which light does notpass as a result of the configuration and orientation of the input,output and surfaces of the illuminator. The dead zones may includeelements to allow the illuminator to securely engage the retractor. Theilluminator may be characterized as having a light input portion, alight conducting portion and a light output portion.

The light input portion of the illuminator receives light from anexternal light source. Such a light source may be an external light box,e.g., a xenon light box, to which one end of a fiber optic light guidecable is attached to conduct light to the surgical field. In thisinstance, the other end of the fiber optic cable would be the source oflight for the blade insert illuminator, for example, by employing amating connector on the illuminator so that it may connect to the fiberoptic cable. The light input portion may also include a tab, finger orother projection extending from a dead zone to engage the retractorblade at the top or handle end, the projection may be permanentlyintegrated or temporarily attached.

The light conducting portion of the illuminator typically is responsiblefor conducting light from the light input section to the light outputsection. It may be simply a section of optical material designed tosupport total internal reflection that is integral with the light inputand light output portions. Surface treatment, e.g., polishing orreflective coating, and the continuous air gap may be used to supporttotal internal reflection.

The light output portion of the illuminator contains from two to eightoutput zones of generally similar depth, each zone having speciallydesigned output optical structures that control and direct light toescape the illuminator to shine onto a predetermined area of interest orto have a predetermined shape or footprint. Such structures may bemolded or cut into the light output zones.

An air gap retractor illumination system includes any suitable retractorsuch as a McCulloch with a channel in the blade to accommodate an airgap illuminator. The illuminator is preferably made from a suitablelight conducting plastic material such as acrylic or polycarbonate orsilicone. The illuminator has active portions in which light passes andinactive or dead zones in which light does not pass as a result of theconfiguration and orientation of the input, output and surfaces of theilluminator. The illuminator is formed to have an air gap surroundingany active portion of the illuminator extending from the light input tothe light output portion. The dead zones may include elements to allowthe illuminator to securely engage the retractor. The light outputportion of the illuminator contains from two to eight output zones, eachzone having specially designed output optical structures that controland direct light to escape the illuminator to shine onto a predeterminedarea of interest or to form one or more predetermined shapes orfootprints.

A blade insert illuminator may comprise one or more illuminator sectionsdesigned to engage a mating channel or channels formed in the blade. Theilluminator is preferably made from a suitable light conducting plasticmaterial such as acrylic or polycarbonate or silicone. Blade insertilluminators may be characterized by having a light input portion, alight conducting portion and a light output portion. The bladeilluminator may be oriented at any suitable position along the retractorblade channel.

The light input portion of a blade insert illuminator receives lightfrom an external light source. Such a light source may be an externallight box, e.g., a xenon light box, to which one end of a fiber opticlight guide cable is attached to conduct light to the surgical field. Inthis instance, the other end of the fiber optic cable would be thesource of light for the blade insert illuminator, for example, byemploying a mating connector on the illuminator so that it may connectto the fiber optic cable. The light input portion may include a shortsection of a light conducting material, such as for example, a suitableplastic or a fiber optic bundle, that is permanently integrated ortemporarily attached.

The light conducting portion of a blade insert illuminator typically isresponsible for conducting light from the light input section to thelight output section. It may be simply a section of optical materialdesigned to support total internal reflection that is integral with thelight input and light output portions. Any suitable surface treatment,such as for example, polishing, reflective coating, anti-reflective (AR)coatings and or dielectric coatings may be used to support totalinternal reflection.

The light output portion of a blade insert illuminator containsspecially designed output optical structures that allow light to beextracted from the illuminator to shine onto a predetermined area ofinterest. Such structures may be molded into the light output portion orsuch structures may be applied, for example, as a film.

A blade insert illumination system may consist of a single illuminatorthat contains the light input, light conducting and light outputportions in a simple, single device that acts as a waveguide. Such asystem may also be comprised of different sections of illuminatorcomponents that attach together to form a complete system. In this case,there may be a light input section designed to receive light from alight source, one or more light conduit sections designed to conductlight from the light input section to a light output section, and alight output section containing the optical output structures that allowlight to escape and illuminate a predetermined area of interest, saidsections attaching together to form a complete system. Each section actsas a waveguide and may employ optical structures to polarize and orfilter the light energy entering or exiting the waveguide.

A blade insert illuminator must be designed and fabricated to maximizelight transfer from the light source or fiber optic input cable andminimize light loss from the waveguide in order to provide an efficientlight transmission system. Efficiency is particularly important for LEDand other light sources, e.g., halogen or xenon lamps, because itdirectly determines the required brightness of the LED. An inefficientwaveguide experiences significant light loss, typically 60% of light maybe lost from input to output. Such a light guide would require a highpower LED to provide sufficient light. A high power LED requires a lotof power and generates significant heat, thereby requiring largebatteries and bulky and inconvenient heat sinking devices and methodsthat add to the size and increase the difficulty of using such a device.Other high power light sources often require noisy fans, which maydisturb the medical personnel conducting a surgery or medical exam.Lamps used in high power light sources have a limited life time,requiring frequent and expensive replacement, due to the need to drivethe lamp at high power levels to generate enough light. An efficientwaveguide, one in which light loss is typically less than 30%, allows amuch lower power LED or other light source to be used, therebysignificantly reducing or eliminating the need for special heat sinkingdevices and methods, reducing cost, and improving the usability of thedevice. The design of an efficient blade insert illumination waveguidemay involve special design of the light input portion of the waveguideto efficiently capture the incoming light, for example, by carefulselection of numerical apertures or using a lens, design and fabricationof the light reflecting walls of the light conducting portion of thewaveguide to maintain surface finish to maximize reflection and reducelight lost through refraction, the use of reflective or dampeningcoatings, the design of light directing optical structures that directthe light toward the light output optical structures while minimizinglight loss through refraction, and or the design of light output opticalstructures that maximize light exiting the waveguide through refraction,particularly refraction of light in certain directions, while minimizinglight lost through reflection.

A blade insert illumination system includes one or more illuminationelements composed of a transparent or semi-transparent polymer that ispreferably biocompatible and sterilizable. The illumination elementsoperate as a waveguide and may incorporate optical components such as,for example, symmetric or asymmetric facets, lenses, gratings, prismsand or diffusers to operate as precision optics for customized deliveryof the light energy. The illumination elements may be modular, allowingcomponents to be mixed and matched for different sizes of bladeretractors, or may be a single integrated unit. Each module may alsohave different performance characteristics such as a diffuse lightoutput or a focused light output allowing users to mix and match opticalperformance as well.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a blade insert illuminator.

FIG. 1A is a cross-section of the blade insert illuminator of FIG. 1taken along A-A.

FIG. 1B is a cross-section of the blade insert illuminator of FIG. 1taken along B-B.

FIG. 2 is a perspective view of an alternate blade insert illuminator.

FIG. 2A is a perspective view of the attachment mechanism of the bladeilluminator of FIG. 2.

FIG. 3 is a perspective view of another blade insert illuminator.

FIG. 3A is a close perspective view of the light output section of theblade illuminator of FIG. 3.

FIG. 3B is a close perspective view of a conduit section of the bladeilluminator of FIG. 3.

FIG. 3C is a front view of a light ray path for a light conduit sectionof the blade illuminator of FIG. 3.

FIG. 4 is a perspective view of a single waveguide blade illuminatorwith a flexible input coupling for a short blade retractor.

FIG. 5 is a perspective view of a single waveguide blade illuminatorsystem with a flexible input coupling for a long blade retractor.

FIG. 5A is a perspective view of an alternate waveguide bladeilluminator with a rigid input coupling.

FIG. 6 is a perspective view of an alternate attachment mechanism forblade insert illuminator sections.

FIG. 7 is a side view of blade insert illuminator with stepped waveguidesections.

FIG. 8 is a perspective view of an alternate single waveguide bladeinsert illumination system.

FIG. 9 is a perspective view of a single waveguide blade insert with alight directing structure.

FIG. 10 is a perspective view of a single waveguide blade insert with alight directing structure with an attachment mechanism.

FIG. 11 is a perspective view of a single waveguide blade insert with awaveguide element co-molded with a retracting element.

FIG. 12 is a perspective view of an illuminated retractor.

FIG. 12A is an exploded view of the input collar and the illuminationblade input.

FIG. 13 is a cross-section view of the illuminated retractor of FIG. 12.

FIG. 14 is a side view of the illumination blade of FIG. 12.

FIG. 15 is a front view of the illumination blade of FIG. 12.

DETAILED DESCRIPTION OF THE INVENTION

Retractor illumination system 10 of FIG. 1 includes blade retractor 12including channel 13 to engage a fiber optic input 14 and waveguideilluminator 16. Latch 17 serves to mechanically attach waveguideilluminator 16 to fiber optic input 14 so that the resulting assemblymay be moved up and down in channel 13 to any position suitable forillumination. The optical coupling between fiber input 14 and waveguideilluminator 16 is a simple face-to-face coupling, which may be enhancedby use of an index matching gel, or other similar material, applied toeither the fiber input 14 or the waveguide illuminator 16 or both. Lightentering waveguide illuminator 16 is contained within the waveguide withminimal light loss until it reaches output optical structures such asoutput structures 18, where light exits to illuminate the predeterminedillumination area 20. Output optical structures 18 may include one ormore stair stepped facets or lenses that may include a radius or angledface, one or prism structures, one or more diffraction gratings, appliedoptical film, or other optical structures designed to direct theavailable light to the predetermined illumination area 20.

In the cross-section view of FIG. 1A channels 13 of blade 12 engagewaveguide illuminator 16. Any suitable channel configuration may beused, such as, for example, a single channel with a circular or rhomboidcross-section. The section view of FIG. 1B shows a section of bladeretractor 12, waveguide illuminator 16 and fiber input 14, with detailshowing latch 17 which snaps into a hole or detent 14D formed in fiberinput 14 and the latch may be disengaged with a minor amount of force.Output optical structures 18 control and direct output light energy 21which illuminates predetermined illumination area 20.

Alternate blade insert illumination system 22 of FIG. 2 includes bladeretractor 24 that includes light input section 26, one or more lightconduit sections such as light conduit section 27, and a light outputsection such a light output section 28 that includes one or more outputoptical elements such as output optical elements 30. In thisconfiguration, light input section 26 has an integrated fiber opticinput 32. One or more fiber optic strands such as strands 32A and 32Bmay be integrated into the upper portion of light input section 26 bymolding the strands into light input section 26, gluing the strands intoa formed receiving hole 26R formed into the section, or other suitablemethods. A light coupling element such as element 33 may also beincluded to improve light coupling and distribution. A collar such ascollar 34 may be provided to aid in strain relief for the optical fiberinput. Light directing structure 36 causes the light coming into thecenter of the waveguide illuminator to be directed along the sides oflight input section 26. The same light directing structure is shown inlight conduit section 27, serving to direct the light down to the nextsection. Light input section 26 and light conduit section 27 may beprovided without the light directing structure, but this may result in adecrease in efficiency.

Output optical element 30 may have a flat face to which an opticaloutput film is applied to allow light to escape and direct the lighttoward tissues of interest, or output section 28 may have output opticalfilm or molded structures located on or integrated into rear face 28Rthat serve to send light out through output optical element 30.

FIG. 2A shows the blade insert illuminator system of FIG. 2 with lightconduit section 27 removed to show the section attachment mechanismconsisting of one or more male members such as engagement member 38 anda corresponding receptacle such as receptacle 39. Output end 38A of themale member 38 may also include one or more output transmission couplingstructures or optical structures, e.g., a lens, such as lens 38L tofocus the light into the corresponding receptacle. Bottom 39A ofreceptacle 39 may also include one or more input transmission couplingstructures or optical structures, e.g., a lens, such as lens 39L tospread light into its corresponding waveguide. In use, the male membersare pressed into the female receptacles of the subsequent section andfriction holds the sections together.

In this configuration, light conduit section 27 of FIG. 2 may beremoved, allowing light input section 26 and light output section 28 tobe directly connected together, for example, to fit a blade having ashort length or to permit adjustment along the blade retractor of thewaveguide element to adjust the location of the illumination area. Oneor more light conduit sections 27 may be added to the assembly to fitblades of medium or long length thereby providing a modular blade insertillumination system whose components may be mixed and matched as needed.For example, if more than one blade retractor is used in a procedure,one blade may be fitted with a shorter assembly of blade illuminationcomponents to illuminate the upper part of the surgical field and asecond blade may be fitted with a longer assembly of blade illuminationsystem components to illuminate the lower, deeper part of the surgicalfield. Sliding a blade insert illumination system up and down slightlywithin the blade channel allows the illumination area to be adjusted,for example, sliding the light output section closer to the work areaincreases the intensity of illumination and sliding it away from thework area provides a more diffuse, less intense illumination. In thisway, the modular blade insert illumination system may be optimized for aparticular type of work to be performed.

FIG. 3 illustrates an alternate blade insert illumination system 40inserted into blade 12. Blade insert illumination system 40 includeslight input section 40A, one or more light conduit sections such asconduit sections 40B and light output section 40C. Bifurcated fiberoptic cable 41 is integrated into light input section 40A. This bladeilluminator configuration includes an engagement arm 42 and lightdirecting structure 44.

FIGS. 3A, 3B and 3C illustrate details of arm 42 and light directingstructure 44. When two or more modular elements of blade insertilluminator system 40 engage channels 13, the engagement arm 42 of firstelement 40B engages adjacent element 40A to maintain a secure opticalconnection at interface 45 between the elements. Arm 42 is a generallyresilient member to permit flexing at joint 46 which permits tooth 47 toengage the light directing structure of the adjacent element. One ormore light control elements such as light collecting lens 48 may beincluded at the input end of each blade illuminator element such asinput end 49 of light output section 40C. Similarly, light output lens50 may be included at the bottom, exit or output end 51 of a lightconduit section such as conduit section 40B. Lenses 48 and 50 areillustrative of the use of optical structures to aid in the transmissionof light between modules. Any other suitable optical structures such asangled facets, multi-faceted lens structures, spherical or asphericallens may also be used. FIG. 3C illustrates how light travels in a bladeinsert illuminator conduit such as conduit element 40B. Light frombifurcated fiber optic cable 41 first enters the top of light inputsection 40A as illustrated in FIG. 3. Light energy 52 entering a bladeilluminator waveguide such as conduit 40B, either from the fiber opticcable or light collecting lens 48, are guided by light directingstructure 44 and light output lens 50.

Single element blade illuminator 54 is shown in FIG. 4. In this example,retractor 56 has a short blade 57. When used with a retractor having along blade, single element blade illuminator 54 may be adjusted alongthe length of the retractor blade to provide illumination wherever it isneeded.

In this configuration, a short section of fiber optic cable 58 isintegrated into blade illuminator waveguide 60 at the output end and hasany suitable connector 62 such as an industry standard ACMI connector orany other type of standard or proprietary connector, at the input end.Connector 62 is normally connected to a standard fiber optic light guidecable that conducts light from an external light source. Since bladeinsert illumination system 54 is made to minimize light loss, portableLED light sources may be attached directly to connector 62 or via a muchshorter fiber optic light guide cable. Short section of fiber opticcable 58 is flexible and allows considerable latitude in how theconnector 62 and light guide cable are oriented. For example, theconnector 62 may be placed toward handle 56H of retractor 56 or it maybe placed on either side in order to keep out of the way of the surgeonand any other equipment that may be in use.

Single element extended blade illuminator system 64 of FIG. 5 is asimple blade insert illuminator designed to fit long blade retractorssuch a retractor 66. Illuminator waveguide 68 receives light at input69, conducts light through total internal reflection throughout centerportion 68C, and output optical structures such as output structure 70directs the light toward a predetermined area to be illuminated.

FIGS. 4 and 5 illustrate that a blade insert illuminator may be providedin different sizes appropriate for the size of the retractor blade withwhich it is to be used. Blade insert illuminator 72 of FIG. 5A is anextended waveguide blade illuminator with a rigid light input component73 in the place of the short section of fiber optic cable 58 as shown inFIGS. 4 and 5. Rigid light input component 73 allows all of the lightguiding sections, waveguide 74 and rigid light input component 73, to bemolded as one device, thereby reducing cost of the assembly. Supportgussets or flanges such as flanges 75 may be added to provide stability.Flanges 75 may have a coating or film applied to prevent light fromescaping or may be made from a different material, for example, using aco-molding or overmolding process. Rigid light input component 73 mayhave an orthogonal input as shown, requiring light directing structure76 to direct light from connector 62 down to waveguide 74 of thewaveguide illuminator. Rigid light input component 73 may also be formedwith a radius, as shown in FIG. 5, and using total internal reflectionto guide the light from connector 62 to the body of the waveguide. Rigidlight input component 73 may also be made rotatable, thereby allowingthe fiber optic light guide cable to be positioned as needed around thesurgical field to avoid interference with other instruments.

FIG. 6 illustrates alternate modular blade insert illuminator elements80A and 80B showing an alternative placement of latches 82 that hold thewaveguide components together. Keeping the latches off to the side ofthe components, rather than in front as shown in FIG. 3, reduces thelikelihood of the latches being accidentally disengaged or broken bysurgical instruments during the course of a surgical procedure. Anyother suitable mechanisms may be used to attach the modular componentsto each other, e.g., dovetail joints, tongue-and-groove joints,adhesives that are preferably index matching adhesives, etc., tooptimize light coupling from one module to the next. The attachmentmechanisms may also be separate from the optical path, for example,metal pins and sockets may be located in optically inactive areas of themodules.

FIG. 7 is a side view of an alternate modular blade insert illuminationsystem 84 wherein each subsequent waveguide section is lessened inthickness 85. This allows output optical structures such as outputstructures 86 to be placed at the exposed end of the upstream waveguide,thereby allowing light to be directed from each waveguide section suchas sections 84A, 84B, 84C. Each waveguide component such as sections84A, 84B may have a bottom surface that contains output opticalstructures 86 over much of its surface to act as a terminal illuminationcomponent in case no other subsequent waveguide components are attached.Light output section 84C shows stepped output optical structure 88 onthe front side and output optical structures 89 on the back side.Without output optical structures 88 that direct light out of the face,light would be lost out the end of light output section 84C, therefore,the combination of output optical structures 88 and 89 contribute tohigher efficiency through less lost light.

Referring now to FIG. 8, winged blade insert illuminator 90 is shownengaged to retractor 91. Illuminator 90 has integrated wings 92 that mayserve an additional retracting function. Wings 92 are oriented generallyparallel to long axis 87 of illuminator 90. In this configuration, lightis directed to exit output optical structure 94. Light entersilluminator 90 via light input component 95, which may be a fiber opticcomponent or a rigid light conducting component at previously discussed.Because total internal reflection may allow light to enter wings 92, thewings may need a reflective coating to prevent light from exiting thewings and being lost or shining into unwanted directions, such as backinto the surgeons eyes.

FIG. 9 illustrates another alternate blade insert illuminator 90A thathas a light directing element 96, which serves to direct the lightcoming into the middle of the illuminator out toward the wings 92A.Output optical structures such as structures 97 and 98 may be placed onwings 92A and body respectively to provide illumination from bothstructures as shown by the arrows.

FIG. 10 illustrates another alternate blade insert illuminator 90B withan extended light directing element 96B. In this embodiment, opticaloutput structures are placed only on the wings 92B so that illumination,light energy 99, only exits through extended output structures 97B inwings 92B as shown by the arrows. Extended light directing element 96Bhas reflective walls such as wall 93 that extend to output end 90E ofilluminator 90B to maximize light reflected to the wings 92B. Thisconfiguration also includes alternative latch arm 100 oriented near theinterface with retractor 102 to engage cutouts or detents such asdetents 103A, 103B and 103C located in retractor 102. Latch arm 100maybe made of the same material as the waveguide or may be made of adifferent material for durability. For example, latch arm 100 may bemade from steel or titanium and insert molded into illuminator 90B.

Alternatively, a retractor blade may be inserted into one or more slotsin the illuminator waveguide to provide rigidity and or to enablecooperation with surgical site retention apparatus.

Co-molded blade insert illuminator 104 of FIG. 11 includes waveguidesection 106 has been co-molded or over-molded with wing and bodyretractor portions 104W and 104B respectively, which are made of adifferent material. For example, retractor wing and body portions 104Wand 104B may be made of a stronger, glass reinforced plastic or steel ortitanium for strength while waveguide section 106 is molded from asuitable optical material such as acrylic, polycarbonate, silicone orother similar optical materials.

Illuminated retractor 107 as illustrated in FIG. 12 is composed ofretractor blade 108 and illumination blade 109. Retractor blade 108 isshown as a McCulloch style retractor blade for use with a McCullochretraction system although any suitable retractor and or retractionconfiguration may be used. Retractor blade 108 includes one or moremechanical connectors such a mechanical connector 108M and neck slot orchannel 110 to accommodate neck zone 124 and blade slot 111 toaccommodate output blade 125 within retractor blade 108 whilemaintaining an air gap between active zones of the illumination bladeand the retractor. Two or more engagement elements such as blade orplate 112 and tabs 114 secure illumination blade 109 to retractor blade108. Each tab 114 engages one or more engagement receptacles such asreceptacles or recesses 115. Plate 112 is joined to collar 116, and whencollar 116 removably engages input dead zone 122D, the collar surroundsillumination blade input 118. The removable engagement of collar 116 toinput dead zone 122D also brings plate 112 into contact with end surface119 of the retractor blade. Collar 116 securely engages dead zone 122Dand surrounds cylindrical input zone 120 and forms input air gap 120G.Engagement at dead zones minimizes interference with the light path byengagement elements such a plate 112 and tabs 114. Plate 112 engages endsurface 119 and tabs 114 resiliently engage recesses 115 to holdillumination blade 109 fixed to retractor blade 108 without contactbetween active zones of illumination blade 109 and any part of retractorblade 108.

Illumination blade 109 is configured to form a series of active zones tocontrol and conduct light from illumination blade input 118 of thecylindrical input zone 120 to one or more output zones such as outputzones 127 through 131 and output end 133 as illustrated in FIGS. 12, 13,14 and 15. Illumination blade 109 also includes one or more dead zonessuch as zones 122D, 126D and 126E. Dead zones are oriented to minimizelight entering the dead zone and thus potentially exiting in anunintended direction. As there is minimal light in or transiting deadzones they are ideal locations for engagement elements to secure theillumination blade to the retractor.

Light is delivered to illumination blade input 118 using anyconventional mechanism such as a standard ACMI connector having a 0.5 mmgap between the end of the fiber bundle and illumination blade input118, which is 4.2 mm diameter to gather the light from a 3.5 mm fiberbundle with 0.5 NA. Light incident to illumination blade input 118enters the illumination blade through generally cylindrical, activeinput zone 120 and travels through active input transition 122 to agenerally rectangular active retractor neck 124 and through outputtransition 126 to output blade 125 which contains active output zones127 through 131 and active output end 133. Retractor neck 124 isgenerally rectangular and is generally square near input transition 122and the neck configuration varies to a rectangular cross section nearoutput transition 126. Output blade 125 has a generally high aspectratio rectangular cross-section resulting in a generally wide and thinblade. Each zone is arranged to have an output surface area larger thanthe input surface area, thereby reducing the temperature per unit outputarea.

In the illustrated configuration illumination blade 109 includes atleast one dead zone, dead zone 122D, generally surrounding inputtransition 122. One or more dead zones at or near the output of theillumination blade provide locations to for engagement elements such astabs to permit stable engagement of the illumination blade to theretractor. This stable engagement supports the maintenance of an air gapsuch as air gap 121 adjacent to all active zones of the illuminationblade as illustrated in FIG. 13. Neck zone 124 ends with dimension 132adjacent to output transition 126 which extends to dimension 134 at theoutput zones. The changing dimensions result in dead zones 126D and 126Eadjacent to output transition 126. These dead zones are suitablelocations for mounting tabs 114 to minimize any effects of theengagement elements on the light path.

To minimize stresses on the light input and or stresses exerted by thelight input on the illumination blade, the engagement elements arealigned to form an engagement axis such as engagement axis 136 which isparallel to light input axis 138.

Output zones 127, 128, 129, 130 and 131 have similar configurations withdifferent dimensions. Referring to the detailed view of FIG. 14, thecharacteristics of output zone 127 are illustrated. Each output zone isformed of parallel prism shapes with a primary surface or facet such aprimary facet 140 with a length 140L and a secondary surface or facetsuch as secondary facet 142 having a length 142L. The facets areoriented relative to plane 143 which is parallel to and maintained at athickness or depth 144 from rear surface 145. In the illustratedconfiguration, all output zones have the same depth 144 from the rearsurface.

The primary facets of each output zone are formed at a primary angle 146from plane 143. Secondary facets such as facet 142 form a secondaryangle 147 relative to primary facets such as primary facet 140. In theillustrated configuration, output zone 127 has primary facet 140 with alength 140L of 0.45 mm at primary angle of 27° and secondary facet 142with a length 142L of 0.23 mm at secondary angle 88°. Output zone 128has primary facet 140 with a length 140L of 0.55 mm at primary angle of26° and secondary facet 142 with a length 142L of 0.24 mm at secondaryangle 66°. Output zone 129 has primary facet 140 with a length 140L of0.53 mm at primary angle of 20° and secondary facet 142 with a length142L of 0.18 mm at secondary angle 72°. Output zone 130 has primaryfacet 140 with a length 140L of 0.55 mm at primary angle of 26° andsecondary facet 142 with a length 142L of 0.24 mm at secondary angle66°. Output zone 131 has primary facet 140 with a length 140L of 0.54 mmat primary angle of 27° and secondary facet 142 with a length 142L of0.24 mm at secondary angle 68°.

Output end 133 is the final active zone in the illumination blade and isillustrated in detail in FIG. 14. Rear reflector 148 forms angle 149relative to front surface 150. Front surface 150 is parallel to rearsurface 145. Terminal facet 151 forms angle 152 relative to frontsurface 150. In the illustrated configuration, angle 149 is 32° andangle 152 is 95°.

Other suitable configurations of output structures may be adopted in oneor more output zones. For example, output zones 127 and 128 might adopta concave curve down and output zone 129 might remain generallyhorizontal and output zones 130 and 131 might adopt a concave curve up.Alternatively, the plane at the inside of the output structures, plane143 might be a spherical section with a large radius of curvature. Plane143 may also adopt sinusoidal or other complex geometries. Thegeometries may be applied in both the horizontal and the verticaldirection to form compound surfaces.

In other configurations, output zones may provide illumination at two ormore levels throughout a surgical site. For example, output zones 127and 128 might cooperate to illuminate a first surgical area and outputzones 129 and 130 may cooperatively illuminate a second surgical areaand output zone 131 and output end 133 may illuminate a third surgicalarea. This configuration eliminates the need to reorient theillumination elements during a surgical procedure.

While the preferred embodiments of the devices and methods have beendescribed in reference to the environment in which they were developed,they are merely illustrative of the principles of the inventions. Otherembodiments and configurations may be devised without departing from thespirit of the inventions and the scope of the appended claims.

What is claimed is:
 1. An illuminated surgical system comprising: asurgical instrument having a front side, a back side, and one or moreengagement elements disposed on the surgical instrument, wherein theback side is adapted to engage tissue at a surgical site; and anilluminator having a front surface, a rear surface, a light inputportion, a light output portion, and a collar, wherein the illuminatortransmits light therethrough by reflection, wherein the illuminator isdisposed adjacent the surgical instrument such that the rear surface ofthe illuminator is disposed adjacent the front side of the surgicalinstrument, and wherein the one or more engagement elements on thesurgical instrument engage the illuminator or the collar so as tomaintain a first air gap between the surgical instrument andilluminator, and wherein light is extracted from the light outputportion of the illuminator and projected onto a surgical site, andwherein the collar at least partially surrounds the light input portion,and a second air gap is at least partially disposed therebetween, thesecond air gap disposed at least partially circumferentially around thelight input portion.
 2. The system of claim 1, wherein the illuminatorcomprises a plurality of active zones where light is transmittedtherethrough by total internal reflection and a plurality of dead zoneswhere total internal reflection does not occur, and wherein the one ormore engagement elements on the surgical instrument engage theilluminator in one or more of the plurality of dead zones.
 3. The systemof claim 1, wherein the one or more engagement elements on the surgicalinstrument engage the collar.
 4. The system of claim 1, wherein theilluminator comprises a plurality of engagement elements for couplingwith the one or more engagement elements on the surgical instrument. 5.The system of claim 4, wherein the plurality of engagement elements onthe illuminator comprise a retention clip that releasably engages theengagement elements on the surgical instrument.
 6. The system of claim1, wherein the illuminator releasably engages the surgical instrument.7. The system claim 1, wherein the one or more engagement elements onthe surgical instrument comprise a receptacle for receiving a portion ofthe illuminator.
 8. The system of claim 1, wherein the light outputportion comprises a plurality of output zones, each zone formed from aplurality of parallel primary facets alternating with a plurality ofparallel secondary facets.
 9. The system of claim 8, wherein theplurality of primary facets and the plurality of secondary facets aredisposed on the front surface of the illuminator.
 10. The system ofclaim 8, wherein the primary facets and the secondary facets of eachoutput zone have different dimensions and are oriented at differentangles relative to the rear surface of the illuminator.
 11. The systemof claim 10, wherein the primary facets and the secondary facets areoriented relative to the rear surface of the illuminator such that theprimary facet forms a primary angle relative to the rear surface and thesecondary facet forms a secondary angle relative to the rear surface,and wherein at least some of the primary angles are acute.
 12. Thesystem of claim 11, wherein at least some of the secondary angles areobtuse.
 13. The system of claim 8, wherein each output zone has depthrelative to the rear surface of the illuminator, and wherein each depthis the same.
 14. The system of claim 1, wherein the illuminatorcomprises a distal end zone having a rear reflector and a terminalfacet.
 15. The system of claim 1, wherein the illuminator is uncoated.16. The system of claim 1, wherein the light input portion comprises agenerally cylindrical portion transitioning to a generally rectangularneck portion.
 17. The system of claim 1, wherein the front surface ofthe illuminator is planar.
 18. The system of claim 1, further comprisinga film or coating disposed on the illuminator.
 19. The system of claim18, wherein the film or coating supports total internal reflectionwithin the illuminator.
 20. The system of claim 18, wherein the film orcoating extracts light from the illuminator.
 21. An illuminated surgicalinstrument for illuminating a surgical field, the surgical instrumentcomprising: a surgical instrument adapted to engage tissue, the surgicalinstrument having one or more engagement receptacles, a proximal portionhaving a longitudinal axis, a distal portion transverse to thelongitudinal axis of the proximal portion and an arcuate connectorcoupling the proximal and distal portions; and an illuminator shaped tosubstantially conform to the shape of the surgical instrument andcoupled with the surgical instrument with an air gap disposedtherebetween, the illuminator comprising a light input portion adaptedto receive light from a light source, a light conducting portion, alight output portion having a longitudinal axis and adapted toilluminate the surgical field, and one or more tabbed fingers separatedby a gap from the light output portion and adapted to releasably engagethe one or more engagement receptacles on the distal portion of thesurgical instrument, wherein the light input portion, light conductingportion, and light output portion act as a waveguide, and wherein thelight conducting portion conducts light from the light input portion tothe light output section by reflection, and wherein reflection does notoccur in the one or more tabbed fingers, and wherein the lightconducting portion further comprises a curved neck zone and the arcuateconnector of the surgical instrument further comprises a curved neckslot for accommodating the curved neck zone so as to maintain an air gapbetween the light conducting portion and the arcuate connector of thesurgical instrument.
 22. The surgical instrument of claim 21, whereinthe light input portion is transverse to the longitudinal axis of thelight output portion.
 23. The surgical instrument of claim 21, whereinthe thickness of the illuminator tapers from the light input portion tothe light output portion.
 24. The surgical instrument of claim 21,wherein the light output portion comprises a rectangular cross-section.25. The surgical instrument of claim 21, wherein the light conductingportion comprises a rectangular cross-section.
 26. The surgicalinstrument of claim 21, wherein the light input portion comprises agenerally cylindrical proximal portion transitioning to a generallyrectangular neck portion.
 27. The surgical instrument of claim 21,wherein the one or more tabbed fingers on the illuminator comprise oneor more retention clips.
 28. The surgical instrument of claim 27,wherein the one or more tabbed fingers are integrally molded into theilluminator.
 29. The surgical instrument of claim 21, wherein the lightinput portion has an input dead zone where reflection does not occur andan input collar connected to the illuminator in the input dead zone, thecollar surrounding the light input portion and forming an input air gapat least partially circumferentially therearound.
 30. The surgicalinstrument of claim 21, wherein the illuminator is uncoated.
 31. Thesurgical instrument of claim 21, wherein the light output portioncomprises optical structures that extract light therefrom and controland direct the extracted light to shine onto an area of predeterminedshape.
 32. The surgical instrument of claim 31, wherein opticalstructures are molded into the light output portion so as to be integraltherewith.
 33. The surgical instrument of claim 31, wherein the lightoutput portion comprises a plurality of parallel prism shapes eachhaving a primary facet and a secondary facet.
 34. The surgicalinstrument of claim 33, wherein the primary facets and the secondaryfacets are oriented relative to a plane substantially parallel to a rearsurface of the light output portion such that the primary facet forms aprimary angle relative to the plane and the secondary facet forms asecondary angle relative to the plane.
 35. The surgical instrument ofclaim 34, wherein at least some of the primary angles are acute.
 36. Thesurgical instrument of claim 34, wherein at least some of the secondaryangles are obtuse.
 37. The system of claim 1, wherein the surgicalinstrument comprises a surgical retractor blade.
 38. The illuminatedsurgical instrument of claim 21, wherein the surgical instrumentcomprises a surgical retractor blade.